Heart : official journal of the British Cardiac Society
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Observational Study
Surgical ablation of atrial fibrillation in patients with a giant left atrium undergoing mitral valve surgery.
As the efficacy of surgical ablation for atrial fibrillation (AF) is reported to be suboptimal for patients with a giant left atrium (LA), its routine use on this population has remained controversial. We sought to evaluate the clinical outcomes of patients with a giant LA undergoing mitral valve (MV) surgery with/without the maze procedure. ⋯ The concomitant maze procedure improved postoperative rhythm status, clinical outcomes and cardiac functions in patients with a giant LA undergoing MV surgery. This study indicates that the patients with a giant LA undergoing MV surgery may benefit from an addition of the maze procedure.
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To investigate the association between obstructive sleep apnoea (OSA) severity with markers of overnight myocardial injury in patients with refractory angina. ⋯ Very severe OSA is common and independently associated with overnight myocardial injury in patients with refractory angina.
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Randomized Controlled Trial Multicenter Study
Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial.
To examine the effects of home-based transitional palliative care for patients with end-stage heart failure (ESHF) after hospital discharge. ⋯ This study provides evidence of the effectiveness of a postdischarge transitional care palliative programme in reducing readmissions and improving symptom control among patients with ESHF.
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An 80-year-old male with a medical history of hypertension, diabetes and moderate calcific aortic stenosis, presented with ischaemic chest pain at rest. Cardiovascular examination revealed soft systolic murmur only. ECG (see online supplementary figure S1) demonstrated inferolateral ST segment depression with ST elevation in lead aVR, suggesting diffuse subendocardial ischaemia possibly consistent with a threatening left main or proximal left anterior descending (LAD) coronary lesion. Emergency coronary angiography demonstrated tandem smooth stenoses in the proximal left circumflex (LCx) and LAD arteries (figure 1A), which persisted throughout the cardiac cycle, and after 200 mcg bolus of intracoronary nitrate. Aortogram is shown (figure 1B). ⋯ What diagnosis underlies the cause of this patient's symptoms? Congenital coronary artery anomaly.Coronary artery vasospasm.Myocardial bridging.Obstructive coronary artery disease.Unruptured left sinus of Valsalva aneurysm.
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Randomized Controlled Trial Comparative Study
Native valve disease in patients with non-valvular atrial fibrillation on warfarin or rivaroxaban.
To compare the characteristics and outcomes of patients with atrial fibrillation (AF) and aortic stenosis (AS) with patients with AF with mitral regurgitation (MR) or aortic regurgitation (AR) and patients without significant valve disease (no SVD). ⋯ We found that patients with AF and AS on oral anticoagulants may have distinctly different efficacy and safety outcomes than patients with MR or AR or no SVD.